Blue Cross Blue Shield of Texas

Products
Group
HMO Blue Texas
BlueCard PPO
BlueChoice PPO
Small Group (2-50)
Individual
Select Blue Advantage Series III
PPO Select^® Choice Series III
PPO Select^® Saver Series III
BlueEdge^SM Individual HSA
PPO Select Value^® Care^SM
PPO Select Basic^SM
Foundation Hospital Care
SelecTEMP^® PPO
Dental Indemnity USA

General Benefits

In-Network Benefits	Out-Of-Network Benefits
PPO Select Value^® Care^SM, a Preferred Provider Health Insurance Plan pays 50 percent and you pay 50 percent of the allowable amount.	PPO Select Value^® Care^SM, a Preferred Provider Health Insurance Plan pays 50 percent and you pay 50 percent of allowable amount.
Physician office visits paid at 50/50 coinsurance.	Physician office visits paid at 50/50 coinsurance.
Network providers will preauthorize your medical care.	You must preauthorize hospital admissions and certain services.
There are usually no claim forms to file.	You may have to submit claims for reimbursement.
Emergency room visits within 48 hours of accident paid at 50/50 coinsurance.	Emergency room visit within 48 hours of accident paid at 50/50 coinsurance.

* Texas Department of Insurance Form: PPO-IND-VALUE-OLC-2